MEDICARE: HEIDI MARIE WOLFERT OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	2010016792	MO
2	225XP0019X	Physical Rehabilitation Occupational Therapist	056006552	IL

General Provider Information

NPI Number	:	1992066542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI MARIE WOLFERT OTR

Provider Business Mailing Address
First Line	:	3908 SHENANDOAH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-4016
Country	:	US
Telephone Number	:	618-201-1112
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 SHENANDOAH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-4016
Country	:	US
Telephone Number	:	618-201-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	05/30/2012

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